Nearly half of accountable care organizations surveyed said they now intend to stay in the Medicare Shared Savings Program even though they could be facing downside risk soon, a change of heart from previous surveys.

The Medicare Shared Savings Program generated $1.84 billion in savings over three years, which is nearly twice the savings CMS data show, according to a new study commissioned by the National Association of ACOs.

New analyses of the major payment reforms begun during the Obama years suggest they do in fact lower healthcare spending. While the savings are small, they provide a strong argument for HHS Secretary Alex Azar to step up the pace of value-based reimbursement reform.

The 472 Medicare ACOs generated a total of $1.1 billion in savings in 2017, allowing the CMS to make a $313.7 million gain from the program after dishing out bonuses. The savings come as the CMS looks to overhaul the program.